Provider Demographics
NPI:1891487492
Name:BORDELON, JOHN SR (MLS, BA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BORDELON
Suffix:SR
Gender:M
Credentials:MLS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N SAM HOUSTON PKWY E STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-2949
Mailing Address - Country:US
Mailing Address - Phone:800-585-0137
Mailing Address - Fax:
Practice Address - Street 1:1300 N SAM HOUSTON PKWY E STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-2949
Practice Address - Country:US
Practice Address - Phone:800-585-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care